Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity
Authors: Alexander Kutz, Daniel Koch, Sebastian Haubitz, Antoinette Conca, Ciril Baechli, Katharina Regez, Claudia Gregoriano, Fahim Ebrahimi, Stefano Bassetti, Jens Eckstein, Juerg Beer, Michael Egloff, Andrea Kaeppeli, Tobias Ehmann, Claus Hoess, Heinz Schaad, James Frank Wharam, Antoine Lieberherr, Ulrich Wagner, Sabina de Geest, Philipp Schuetz, Beat Mueller
Journal: JAMA Network Open (2022)

Importance Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial. Objective To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity. Design, Setting, and Participants This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022. Intervention After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning. Main Outcomes and Measures Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals. Results There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by −0.344 hr/mo (95% CI, −0.599 to −0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (−0.034 hr/mo; 95% CI, −0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, −0.011 hr/mo; 95% CI, −0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by −0.879 hr/mo (95% CI, −1.607 to −0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time. Conclusions and Relevance In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge. Trial Registration isrctn.org Identifier: ISRCTN83274049